接受注射用二乙酰吗啡或氢吗啡酮治疗慢性阿片类物质使用障碍的人群中尼古丁依赖与身体健康之间的关联。
The association between nicotine dependence and physical health among people receiving injectable diacetylmorphine or hydromorphone for the treatment of chronic opioid use disorder.
作者信息
Palis Heather, Marchand Kirsten, Karamouzian Mohammad, MacDonald Scott, Harrison Scott, Guh Daphne, Lock Kurt, Brissette Suzanne, Anis Aslam H, Krausz Michael, Marsh David C, Schechter Martin T, Oviedo-Joekes Eugenia
机构信息
Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
出版信息
Addict Behav Rep. 2018 Mar 27;7:82-89. doi: 10.1016/j.abrep.2018.03.005. eCollection 2018 Jun.
INTRODUCTION
People with chronic opioid use disorder often present to treatment with individual and structural vulnerabilities and remain at risk of reporting adverse health outcomes. This risk is greatly compounded by tobacco smoking, which is highly prevalent among people with chronic opioid use disorder. Despite the known burden of tobacco smoking on health, the relationship between nicotine dependence and health has not been studied among those receiving injectable opioid agonist treatment. As such, the present study aims to explore the association between nicotine dependence and physical health among participants of the Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME) at baseline and six-months.
METHODS
SALOME was a double-blind phase III clinical trial testing the non-inferiority of injectable hydromorphone to injectable diacetylmorphine for chronic opioid use disorder. Participants reporting tobacco smoking were included in a linear regression analysis of physical health at baseline (before receiving treatment) and at six-months.
RESULTS
At baseline, nicotine dependence score, lifetime history of emotional, physical, or sexual abuse and prior month safe injection site access were independently and significantly associated with physical health. At six-months nicotine dependence score was the only variable that maintained this significant and independent association with physical health.
CONCLUSIONS
Findings indicate that after six-months, the injectable treatment effectively brought equity to patients' physical health status, yet the association with nicotine dependence remained. Findings could inform whether the provision of treatment for nicotine dependence should be made a priority in settings where injectable opioid agonist treatment is delivered to achieve improvements in overall physical health in this population.
引言
患有慢性阿片类药物使用障碍的人在接受治疗时往往存在个体和结构上的脆弱性，并且仍有报告不良健康结果的风险。吸烟会极大地加剧这种风险，吸烟在患有慢性阿片类药物使用障碍的人群中非常普遍。尽管吸烟对健康的负担众所周知，但在接受注射用阿片类激动剂治疗的人群中，尚未研究尼古丁依赖与健康之间的关系。因此，本研究旨在探讨评估长期阿片类药物疗效研究（SALOME）的参与者在基线和六个月时尼古丁依赖与身体健康之间的关联。
方法
SALOME是一项双盲III期临床试验，测试注射用氢吗啡酮与注射用二乙酰吗啡治疗慢性阿片类药物使用障碍的非劣效性。报告吸烟的参与者被纳入基线（接受治疗前）和六个月时身体健康的线性回归分析。
结果
在基线时，尼古丁依赖评分、情感、身体或性虐待的终生史以及前一个月安全注射部位的可及性与身体健康独立且显著相关。在六个月时，尼古丁依赖评分是唯一与身体健康保持这种显著且独立关联的变量。
结论
研究结果表明，六个月后，注射治疗有效地使患者的身体健康状况达到平等，但与尼古丁依赖的关联仍然存在。这些发现可以为在提供注射用阿片类激动剂治疗以改善该人群整体身体健康的环境中，是否应将提供尼古丁依赖治疗作为优先事项提供参考。
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